A study published in Nursing Research yesterday reveals that hospital patient-safety indicators worsened during the COVID-19 pandemic, with higher rates of falls, bloodstream infections from catheters, urinary tract infections from catheters, pressure injuries from devices or immobility, and pneumonia linked to ventilator use.
Researchers from the University of Pennsylvania's Center for Health Outcomes and Policy Research led the study, which also pointed out that while rates of patient injuries and infections are on a downward trend, they had not returned to prepandemic levels by 2022.
The team used data from the National Database of Nursing Quality Indicators repository from 2019 to 2022 on rates of falls, central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), hospital-acquired pressure injuries (HAPI), and ventilator-associated events (VAE). The nationally representative data were reported by 24,244 units in 2,346 hospitals.
Nurses were overwhelmed with disruptions to routine nursing care, which is essential to maintaining safety and preventing adverse patient events.
"The pandemic’s demands on hospital nurses included quickly adopting a crisis standard of care, scarcity of personal protective equipment, supporting patients in the hospital without visitors, and higher patient acuity," the researchers wrote. "Nurses were overwhelmed with disruptions to routine nursing care, which is essential to maintaining safety and preventing adverse patient events."
Highest prevalence in VAE
In order of declining prevalence, the average prepandemic rates were 6.58 VAE per 1,000 ventilator days (critical care only), 2.41 HAPI per 1,000 device days, 2.20 falls per 1,000 patient days, 0.96 CAUTI per 1,000 catheter days, and 0.68 CLABSI per 1,000 central-line days for medical-surgical and critical care units combined.
The highest fall rate in critical-care and medical-surgical units combined was 2.99 per 1,000 patient days in 2020. In critical care units only, significantly lower fall averages (1.34) were seen before the pandemic than in 2020 but were higher in 2019 than 2021. The highest rate was documented in 2020, at 1.43. Medical-surgical units saw a greater increase in falls (14%) than critical care units (7%).
Medical-surgical units didn't have 4 years of VAE data, but in critical care units, significantly lower average VAE rates were documented in 2019 than in 2020, 2021, and 2022. The highest rate was seen in 2021 (9.23), a 40% increase.
In medical-surgical and critical care units combined, significantly lower average CLABSI rates were noted in 2019 than in 2020, 2021, and 2022. The highest value was 0.88 in 2021. In medical-surgical units only, significantly lower average CLABSI rates were observed in 2019 than in 2021. The highest rate was 0.71 in 2021.
Significantly lower average CLABSI rates were also seen in critical care units in 2019 than in 2020, 2021, and 2022. The highest value was 1.18 in 2021. The increase was 29% overall and 49% in critical care.
All five indicators remained high in 2022
Average CAUTI rates stayed steady from 2019 to 2022 in medical-surgical and critical-care units combined. The rate peaked in 2019 and 2021, at 0.96. Likewise, no significant differences in average CAUTI rates were seen from 2019 to 2022 in medical-surgical units. The highest value was 0.96 in in 2019. But significantly lower CAUTI rates were documented in 2019 than 2021 in critical-care units, which saw a 12% increase, but the 2019 rate was higher than that in 2022. The rate peaked in 2021, at 1.05.
It's crucial that we address the ongoing challenges faced by nurses and invest in this professional workforce.
In medical-surgical and critical care units combined, HAPI rates were significantly lower in 2019 than in 2020, 2021, and 2022. The highest value was 3.35 in 2021, a 39% increase. Similar findings were documented in medical-surgical units in 2019 than in the following 3 years. The rate peaked at 1.76 in 2022, a 31% increase. Significantly lower average HAPI rates were seen in 2019 than in 2020, 2021, and 2022 in critical care units. The highest value was noted in 2021, at 6.41, a 44% increase.
The rates for all five nurse-sensitive indicators increased significantly beginning in 2020 and have begun to decline but had not returned to baseline by 2022.
"We interpret the upward trends as a result of two factors described previously: the disruption in nurses’ work and higher patient acuity," the researchers wrote. "The disruptions to work processes and the infusion of higher acuity, predominantly COVID-19 patients, compromised nurse surveillance and nursing interventions to prevent the occurrence of NSIs [nursing-sensitive quality indicators]."
The authors called for nursing managers to vigilantly monitor nursing quality indicators and to take and evaluate new approaches to meet care requirements during a shortage of nurses using technology and innovative models of care.
In a University of Pennsylvania School of Nursing news release, lead author Eileen Lake, PhD, RN, said, "The pandemic placed an immense strain on healthcare systems and frontline workers, and the impact on patient safety is evident in these data. It's crucial that we address the ongoing challenges faced by nurses and invest in this professional workforce."
